21 October 2008
Maputo — Problems associated with access to antiretroviral drugs (ARVs) in Mozambique will not be solved by the establishment of a new factory alone, since this is a much more complex issue, Health Minister Ivo Garrido has warned
Currently, there are estimated to be over 300,000 HIV-positive people in need of ARVs across the country, but less than half this number have access to free ARV treatment.
According to Garrido, the new pharmaceutical plant producing ARVs, funded by Brazil, will ease the financial burden faced by the government in purchasing these drugs, but will not solve the problem of access.
"A country that produces medicines locally has advantages in terms of procurement of drugs. There are a number of steps related to procurement, which are removed when there is a factory in the country. That's one of the advantages of having a factory", Garrido told reporters.
"The plant will ease matters for the government since, rather than having to wait for medicines and go through all the process of clearing them through customs, now the government will just collect them from Matola, and that's simple", he added
Matola is the industrial city adjoining Maputo, where the Brazilian ARV plant is to be built. The site has already been identified.
Garrido explained that the problem of access to antiretrovirals arises because most of those infected with the HIV virus are unaware of their status, and hence they fail to associate their constant pain and ill health with AIDS. They make repeated visits to health centres, not knowing that HIV infection is the underlying cause of their problems..
"It would be nice and easy if the problem was just limited to the availability of ARVs. If that was the case, we would simply buy medicines and the problem would be solved", said Garrido.
However, said the minister, "the problem is more serious and deep, and is related with society. It's false to claim that people don't have access to ARVs because the drugs are not available. The main reason is that most people are unaware that they are ill".
"How do you deal with a person who does not know that what makes him sick and causes diarrhoea, headaches, weakness or other health problems is HIV, and the same person is unable to associate those problems with HIV/AIDS?", exclaimed Garrido.
Garrido challenged reporters to present specific cases of individuals in need of ARVs, but unable to obtain them. "If you meet a person needing ARVs, and unable to gain access to them, bring that person to my office. Bring him to my office. The problem of access to treatment is real, but has nothing to do with the availability of drugs", he said. The Health Ministry says that, even before the factory is built, imported ARVs are available in all of Mozambique's 128 districts.
Not every HIV-positive person needs to take antiretrovirals. Treatment is only administered to those who are already showing symptoms of AIDS, and are very weak and vulnerable to opportunistic diseases. ARVs are administered to patients to boost their immune system, to allow them to carry on a normal lifestyle.
Once a person starts taking ARVs, he will have to go on taking the drugs for the rest of his or her life.
But there has been a trend for a growing number of patients to give up ARVs for a number of reasons. Some of them claim a lack of food as the main reason for quitting treatment. They claim that sometimes they have little or nothing to "fill their stomachs", and effective ARV treatment demands a diet rich in vitamins and proteins.
Moreover, the distance from the health centres is one of the factors for quitting treatment. Patients receive medication for 15 days, and then they must return to the health unit to check their CD4 count (which measures the quantity of the protective cells in the immune system that are destroyed by the virus), receive medicines and further guidance.
Often, these health centres are located far from their communities, requiring money for transportation, which sometimes patients are unable to afford.
The government says it has resources for expanding ARV treatment. 'There is no shortage of anti-retroviral drugs in Mozambique", stressed Garrido, though he admitted "eventually this could happen in future due to the increase in the number of beneficiaries".
The reason for the relatively low coverage rate lies in other factors, such as the shortage of medical staff to monitor patients, check their diet and the intake of their medicines - but particular the sheer lack of knowledge among sufferers of their HIV status.
Garrido insists that the main problem in access to treatment is lack of communication, because it is difficult to help people who are unaware of their status.
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